Unexpected primary fallopian tube carcinoma during gynecological operations: Clinicopathological and prognostic factors analyses of 67 cases

Abstract

Objective: The aim of the study was to analyze the clinicopathologic features, the survival rate, and the prognostic factors of women with unexpected primary fallopian tube carcinoma diagnosed during gynecological operations. Materials and methods: We reviewed medical records of patients with unexpected primary fallopian tube carcinoma at the Obstetrics and Gynecology Hospital of Fudan University between January 2004 to December 2017. The survival analysis was based on the Kaplan–Meier method, and the results were compared using the log-rank test. Cox regression analysis was used to determine factors affecting survival. Results: Sixty-seven patients with unexpected primary fallopian tube carcinoma were identified. The 5-year overall survival was 49.7%, the mean overall survival was 64 months [95% confidence interval (CI) 54–74], and the median overall survival was 59 months (95% CI 49–69). The mean follow-up time was 53.9 months (range 5–141 months). The most common clinical presentation was adnexal mass (38.8%), followed by vaginal bleeding (16.4%) and no specific symptom (13.4%). Cytoreductive surgery was performed initially in 57 (85.1%) patients. Residual disease was optimal in 56 (83.6%) patients and suboptimal in 11 (16.4%) patients. The histological subtype was predominantly the serous type (88.1%). 44 patients (65.7%) were diagnosed at Stage I/II postoperatively. 23 (34.3%) patients were in Stage III/IV. 51 patients (76.1%) had gone through laparoscopic surgery, 16 patients (23.9%) were performed laparotomy. Univariate analyses on overall survival revealed that only the International Federation of Gynecology and Obstetrics (FIGO)stage [p < 0.001; Hazard Ratio (HR), 6.433; 95% CI, 2.274–18.199], residual tumor (p = 0.014; HR, 4.957; 95% CI, 1.378–17.831) were significant prognostic factor. Pelvic lymphadenectomy did not show association with overall survival in our univariate or multivariate analyses. After an observation period of 70 months, we found an increased overall survival in the group of without lymphadenectomy. Conclusions: The diagnosis of primary fallopian tube carcinoma is rarely considered preoperatively. The early stage and optimal debulking surgery with residual tumor ≤1 cm are important independent factors to improve patients' prognosis. However, there were no statistically significant correlations between lymphadenectomy and prognosis. The value of lymph node sampling or dissection needs to be reconsidered. Keywords: Primary fallopian tube carcinoma, Overall survival, The FIGO stage, Residual tumor, Lymphadenectomy